James Harold Dyer Jr., LMT – Massage Therapist

Key facts

NPI: 1811528342
Entity type: Individual (NPI type 1)
Primary specialty: Massage Therapist 225700000X
License: 6329 (NM)
Practice address: 18648 C Private Dr,
Espanola, NM 87532-8753
Phone: (505) 753-7576
NPI assigned: Feb 3, 2020
Sex: Male
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
6329	NM	MD	Massage Therapist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Massage Therapist	225700000X	6329	NM	Yes

Addresses

Primary practice location

18648 C Private Dr,
Espanola, NM 87532-8753

Mailing address

18648 C Private Dr,
Suite C
Espanola, NM 87532
Phone (505) 753-7576

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 3, 2020.

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1811528342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18648 C PRIVATE DR,",
            "address_2": "SUITE C",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "87532",
            "telephone_number": "505-753-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18648 C PRIVATE DR,",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875328753",
            "telephone_number": "505-753-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYER",
        "first_name": "JAMES",
        "middle_name": "HAROLD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-03",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NM",
            "license": "6329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Espanola, NM

All providers in Espanola, NM · Massage Therapist in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.